Australasian Dentist Issue 93

CATEGORY 62 AUSTRALASIAN DENTIST How to develop an aesthetic treatment plan The challenge when treatment planning for cosmetic procedures Dr Giulia D’Anna By Dr Giulia D’Anna, BDSc, MRACDS, Grad. Dip. Derm. Th Cert IV TAE, Grad. Cert laser T reatment planning for cosmetic procedures is a challenge, when we compare it with the regular dental interventions. One reason is that minimal invasive cosmetic procedures are constantly evolving and there appears to be so many different guidelines to follow. Another difference is the input of the patient. When a patient sees a dentist for an examination, for example, the treatment planning is largely done by the dentist, with only minimal input from the patient. After all in dentistry, most of what the dentist does, cannot be visually seen by the patient. This is very different when it comes to cosmetic injectable treatments. Our work is now on the outside and what the patient is concerned about, and has sought our opinion about. There may also be slight different approaches among practitioners, but when following existing guidelines, we might assume quite consistent and reproducible treatment suggestions. But when it comes to aesthetics and cosmetic procedures, the rules are different. Communication is key to treatment planning Just like in all dental scenarios. In order to successfully meet the patient’s goals, it is important that the patient clearly communicate the desired changes that are to be achieved. Occasionally, a patient will offer a broad concern such as “I just don’t like my face.” In this case, the practitioner should be able to identify aspects of the face that deviate from the aesthetic norm. When these features are presented to the patient, there is frequently immediate acknowledgement from the patient that this is also an area of concern, but perhaps something that they had never considered. This is often as they were unaware that the “problem” could be corrected, or their focus was elsewhere and they just didn’t see the aesthetic deviation that we may have pointed out. This helps to form a clarification of treatment objectives. The practitioner should feel that he/she is not leading the patient. To some extent, the result depends on the anatomy and physiology with which the patient presents. It is important that the patient realizes the limitations to what can be achieved in given individuals. With cosmetic injectable and skin treatments, patients are more likely to take responsibility for the treatment planning. They might even try to be the decision makers of what should be treated and with what kind of product should be injected. We cannot let the patient take the reigns on that decision. It would be the equivalent of telling an artist, which paint and paintbrush to use to get the end result. For some less experienced injectors, this might be even welcome because they find themselves relieved from designing an accurate treatment plan for their patients. For the experienced injector, however, this might pose a challenge. We need to ensure that the patient knows we are the expert, and we welcome input from the patient, but not about the technical aspects of our role. Similarly, the practitioner must be able to identify the areas of concern. One of the most crucial aspects of the aesthetic consultation is to make certain that the practitioner understands the patient’s goals and that these goals are realistic. Photos are a useful tool to help determine patient goals andwill be discussed.The practitionermust also honestly assess their ability to achieve the result. It is wise to be conservative in cosmetic injecting at the beginning of your journey. This may mean referring a difficult case to a more experienced practitioner or staying within one’s comfort zone to avoid doing irreparable harm. It is better to return for aminor revision than create the need for a major revision. Limiting factors Over the course of my career so far, I have found that the dental practitioner often is a major limiting barrier to achieving a nice aesthetic outcome. Not because they lack the skills or knowledge in the procedure that needs to be undertaken. But rather they find themselves in an uncomfortable position when pointing out areas of the face that are not aesthetically pleasing. Many times I have heard phrases like: “You are so beautiful, you don’t need any work” “Oh don’t be silly. You look great already.” “We only need to do a tiny bit of work, because you look so lovely already.” Whilst these statements may be true, you need to help your patient. The patient sought your advice to correct their aesthetic concern. Address the concern andwhatever else your eyes see. Do not limit the patients LINICAL